Summary & Overview
CPT 19342: Breast Implant Insertion or Replacement After Mastectomy
CPT code 19342 represents insertion or replacement of a breast implant performed after a prior mastectomy. This reconstructive procedure is an essential component of post-mastectomy care and has national relevance for surgical practices, oncology care teams, and payer coverage policies. Decisions about implant reconstruction affect patient recovery, aesthetic outcomes, and care coordination between surgical and oncologic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 19342, typical settings where the procedure is performed, and the main payer landscape. The publication outlines common billing considerations, commonly applied modifiers (list provided in input), and where to look for documentation and coding guidance.
This summary provides benchmarks and policy context relevant to hospitals and ambulatory surgical centers, highlights factors that influence site-of-service decisions, and summarizes documentation elements that commonly accompany reconstructive implant procedures after mastectomy. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19342 describes a procedure in which, after a prior mastectomy (breast excision), a provider inserts or replaces a breast implant. This service is a breast reconstruction procedure performed following mastectomy and is typically classified as reconstructive surgery.
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Service type: Reconstructive breast surgery (implant insertion or replacement following mastectomy)
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Typical site of service: Ambulatory surgical center or inpatient/outpatient hospital surgical setting, depending on clinical complexity and patient needs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old female who underwent a unilateral mastectomy for breast cancer two years prior presents for staged reconstruction. The patient previously had a tissue expander placed at the time of mastectomy and has completed adjuvant chemotherapy and radiation. At this visit, the plastic surgeon performs surgery to remove the tissue expander and insert a permanent silicone gel breast implant under the pectoralis major muscle. The surgical workflow includes preoperative verification, informed consent for implant exchange, general anesthesia, removal of the expander, pocket irrigation and assessment, insertion and positioning of the permanent implant, hemostasis, layered closure, and standard postoperative recovery and discharge instructions.
The typical site of service is an outpatient ambulatory surgery center or hospital outpatient department. Typical supporting clinicians include a board-certified plastic surgeon (primary operator), an assistant surgeon or physician assistant as indicated, a certified registered nurse anesthetist or anesthesiologist, and perioperative nursing staff. Billing uses 19342 for exchange or insertion of a breast implant performed after mastectomy; documentation should include prior mastectomy history, reason for exchange (definitive reconstruction, capsular contracture, infection resolution, implant rupture), details of implant type and size, laterality, and any additional procedures performed during the same operative session.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | When a separate procedural service not normally reported together is performed at a different site or session |
51 | Multiple Procedures | When more than one procedure is performed during the same operative session (used when bundling rules apply) |
52 | Reduced Services | When the service performed is partially reduced or eliminated at the physician's discretion |
53 | Discontinued Procedure | When the procedure is started but discontinued due to unforeseen circumstances |
76 | Repeat Procedure by Same Physician | When the same procedure is repeated later the same day by the same physician |
77 | Repeat Procedure by Another Physician | When the same procedure is repeated later the same day by a different physician |
62 | Two Surgeons | When two surgeons work together as primary surgeons of different specialties for a single complex procedure |
80 | Assistant Surgeon | When a qualified assistant surgeon participates in the procedure |
66 | Surgical Team (Cardiac/Transplant context) | Rarely used; only when a surgical team approach is documented and payer allows |
RT | Right Side | When the procedure is performed on the right breast |
LT | Left Side | When the procedure is performed on the left breast |
50 | Bilateral Procedure | When identical procedures are performed on both breasts (bilateral) |
22 | Increased Procedural Services | When work required to provide a service is substantially greater than typically required |
78 | Unplanned Return to OR, Related Procedure | When the patient returns to the operating room for a related procedure during the postoperative period |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2084P0805X | Plastic Surgery | Board-certified plastic surgeons perform breast reconstruction and implant exchange procedures |
207P00000X | General Surgery | General surgeons may be involved when oncologic re-operation or mastectomy revisions are required |
363A00000X | Anesthesiology | Provides general anesthesia or monitored anesthesia care for the procedure |
206E00000X | Physician Assistant | May assist intraoperatively under surgeon supervision |
367A00000X | Registered Nurse First Assist | May function as an assistant in the operative field when credentialed |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z42.1 | Encounter for breast reconstruction following mastectomy | Common reason for implant insertion or exchange after prior mastectomy |
C50.919 | Malignant neoplasm of unspecified site of unspecified female breast | Underlying breast cancer diagnosis that may have led to prior mastectomy and subsequent reconstruction |
T85.698A | Other complications of breast prosthesis, initial encounter | Codes complication scenarios such as malposition, rupture, or pain prompting implant replacement |
T86.898 | Other complications of transplanted organ and tissue, initial encounter | Occasionally used for complex implant-related complications when tissue issues arise |
Z43.3 | Encounter for attention to other plastic and reconstructive operations on the skin | Administrative code used for subsequent reconstructive procedures including implant exchange |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19357 | Breast reconstruction with tissue expander, placement | Performed earlier in a staged reconstruction; the expander may be the item exchanged during 19342 |
11970 | Replacement of tissue expander with permanent implant | Alternative code sometimes used by payers; documents conversion from expander to implant (ensure correct reporting per payer rules) |
19318 | Reduction mammaplasty | May be performed concurrently if contralateral symmetry procedures are required during reconstruction |
19499 | Unlisted breast procedure | Used only when a billed service related to breast reconstruction cannot be accurately described by existing codes (rare for standard implant exchange) |
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., for diagnostic or therapeutic injections) | Not directly related but included occasionally for coding crosswalks when coding adjunctive procedures; generally not used for implant exchange |